luvkids: What do I do now?

[ChessieCat]

There are many existing topics on this site.  I like to use a search engine and add site: survivingantidepressants.org to my search term.

 

There is a discussion about weight gain/loss.  Do a search for weight loss.

[ShiningLight]

This takes some discipline, but it worked for me on more than one occasion.

 

If you can't sleep, get out of bed and read the doggone phone book, if you have a paper one. I'm serious. It is incredibly boring. Read the people pages. Start at the top of the page and read a bunch of names like you're reading a book. Once you can't stand that anymore, climb back in bed. Try to sleep for 20 min.

 

If you can't fall asleep, get out of bed. You know what to do.

 

You probably aren't going to go through too many cycles of this before falling asleep out of desperation not to go read the phone book.

[luvkids]

So any ideas on how to stop being hyper alert to the start of any symptom on a given day?  I find myself constantly monitoring my body for any symptoms, and when one starts, I get anxious just thinking that it will get worse.  I am sure this is counterproductive, but I don't know how to stop it. I do use deep breathing a lot, which sometimes helps the symptom, but not my obsessing with the start of a symptom.

[bijay]

@luvkids  First, give yourself credit for being able to recognize that this is happening, and that this obsessive thinking is counterproductive.
 

Make up a list of things you can do to redirect your mind, and keep it in your back pocket.  When you start to obsess over a symptom, pull that list out and pick something - counting backwards by seven, writing your name ten times with your non-dominant hand, whatever.  Consistency is key;  it will not work at first, but over time you will see improvement.

 

Are you familiar with the idea of brain neuroplasticity? The brain is not static, it can literally be rewired to our benefit, using     techniques like CBT.  It is the subject of Norman Droige’s book called “The Brain’s Way of Healing.”  For me this book was a revelation, and I highly recommend it.

[ChessieCat]

bijay has the same idea as me.  I was going to make the suggestion that you find things to do to distract yourself.  If you are able to you could put on some music that you like and dance to it.  Go outside and look for flowers, nice leaves, look at the clouds, trees, look for a certain coloured car driving bay.  There are lots of things that you could do.  Having a list is helpful because the only thing you have to do is to remember to look at it.  If happens first thing in the day or seems to happen at certain times of the day, you could set a reminder.

 

And yes, it can be hard to start but it does become easier.

[luvkids]

OK, tomorrow is my appointment with a psychologist....first time for  me.  I wrote out a history for him of what I have been thru and the symptoms I have experienced, including being fine for multiple months and then experiencing withdrawal and how the symptoms are completely different from what I was experiencing before going on Paxil.  I hope to read that to him at the start of the session.  My question for you guys is IF he tells me to restart an AD, (not sure if he can prescribe Paxil....my GP could not at my age, but supposedly psychiatrists have more leeway), and IF I decide that is the route I want to go, what amount would you suggest starting with?  My last dose was May 2019 at approximately 2.5 mg.  I never weighed or real accurately measured the pills.....just kept cutting a 20 mg. tablet in half, in half again, etc.  I am thinking that if I go back on it, I will likely be on it for the rest of my life, as I do not wish to go thru this hell again.  I really thought when I went thru my last withdrawal stage 11 months ago, which lasted about a month, and then was fine for 10 months, that I was done healing.  AS I have said before, I had no problems while on Paxil, unlike the stories of so many on this site who have had horrible experiences going on and off multiple drugs.  There was no real reason to go off it.  I do not like drugs, and am usually resistant to them,  but with the stress from covid continuing into the foreseeable future, and finding even little things like going grocery shopping....which I hardly can even do anymore since I am so exhausted and spacey I can hardly thing straight...or even just seeing an article about the virus (I no longer read the paper or watch the news, but it is impossible to completely aviod it) can start my symptoms up.  The thought of these symptoms going on and on, or never knowing when they may show up again, is very hard to take.  So anyway, would you have a recommended start amount if I do go back on a med?  GP was going to use Celexa a year ago, but I never took it.  I know I will likely feel like a failure if I give up, but.........

[ChessieCat]

9 minutes ago, luvkids said:

what amount would you suggest starting with?  My last dose was May 2019 at approximately 2.5 mg.

 

A very tiny amount.  It is very important to get a consistent and accurate dose.

 

Tips for tapering off Paxil (paroxetine)

 

Paxil is available as a liquid and it lasts up until the expiry date, not 1 month after opening like many other liquid ADs.

 

On 5/27/2011 at 10:52 AM, Altostrata said:

 

Use Paxil liquid to taper

 

(NOTE:  Paxil Oral Suspension is stable until expiry date when stored correctly - see this post; Seroxat contents to be discarded 1 month after opening - see this post)

This is the easiest and most accurate way to taper Paxil.

 

 

Please read Post #1 of this topic:

 

About reinstating and stabilizing to reduce withdrawal symptoms

 

I suggest reading through it and taking notes and then a few hours later read through it again.  And possibly even doing that a third time, because there is a lot of information in that post and it can be hard to digest it all at one time.

[Altostrata]

17 minutes ago, luvkids said:

My question for you guys is IF he tells me to restart an AD, (not sure if he can prescribe Paxil....my GP could not at my age, but supposedly psychiatrists have more leeway)

 

Are you seeing a psychologist (provides therapy) or a psychiatrist (provides drugs)?

 

Why could your GP not prescribe Paxil "at your age"?

 

Most medical doctors of any sort are not able to recognize withdrawal syndrome and would say you'd relapsed into a psychiatric disorder. For this, they'd cheerfully prescribe any number of drugs or drug combinations. They might even give you your choice.

 

If you're interested in reinstating an SSRI for Paxil withdrawal syndrome, since you've been off Paxil for so long, I would start with a tiny amount of Prozac, such as 0.5mg. It comes in liquid form so you can take a very low dose to see how it affects you. If I were you, I wouldn't take Paxil again, it's among the worst to go off.

 

On 8/1/2020 at 9:51 AM, luvkids said:

So any ideas on how to stop being hyper alert to the start of any symptom on a given day?  I find myself constantly monitoring my body for any symptoms, and when one starts, I get anxious just thinking that it will get worse.  I am sure this is counterproductive, but I don't know how to stop it. I do use deep breathing a lot, which sometimes helps the symptom, but not my obsessing with the start of a symptom.

 

This is the sort of thing a psychologist or a coach in meditation can help you with. Unlikely that a psychiatrist would do anything but give you a prescription.

 

 

[ChessieCat]

However, I think you should consider some things before reinstating. 

 

Paxil, 20 mg. daily for last 20 years

Began tapering October 2018.  Took last dose May 2019.

 

You did a very fast taper of 7 months after being on Paxil for 20 years.

 

You have only been off Paxil completely for 14 months.  This is not very long in the scheme of things.  If you can learn non drug ways to reduce your stress your brain will be better able to stabilise.

 

It is possible to learn life coping skills, self soothing and non drug coping techniques to help us to cope with life stressors.  The drugs don't stop life stressors happening, they just numb our emotions.

 

Even if reinstatement works, Paxil may not work the same way it did when you previously took it.

 

Reinstatement may not work, and it might make things worse.

 

If you start taking Paxil again and you end up going to a "regular" dose, if in the future you need to take medication for a health issue, there could be a drug interaction.

 

If you feel that you have no choice but to take an antidepressant, then it might be better to consider taking a different drug.  If you do decide to do that, then I suggest that before taking anything you do a lot of research on side effects etc.

 

[luvkids]

My doctor told me that Paxil has a black box warning for people over 65 for an increased risk of falling. He said he was not allowed to prescribe it.  He was going to give me Celexa.  I did try Prozac for a very short time before going on paxil, but it made me extremely agitated.  I am going to see a psychiatrist.  I totally understand the idea of learning coping skills, and I never felt "numb" while on Paxil....just normal and good.  Had I had a bad experience, I would not be considering going back on something.  Would Celexa be a better choice than Paxil?  Does it come in a liquid?  

[ChessieCat]

SA has a Tips for Tapering topic for many antidepressants.  It's easy to do a search, using a search engine and adding site: survivingantidepressants.org to the search term.

 

 

[luvkids]

I do intend to address the severe insomnia issue as well to see if there is some help for that before starting an AD.  I just feel like a zombie......so exhausted I sometimes stumble, cannot go do errands, visit with my grandkids, and I never know when the withdrawal symptoms will kick in or when they will stop.  It is just so random without rhyme or reason.

[ChessieCat]

When reducing/going off a drug, it can be very easy to think that what we are experiencing is withdrawal when it is possible that there is something else that is causing the symptoms or making withdrawal symptoms worse.

 

2 hours ago, luvkids said:

the stress from covid

 

America has also has/had the riots and you've also got the upcoming election.  There is a lot of external stressors affecting people at the moment.

 

2 hours ago, luvkids said:

I do intend to address the severe insomnia issue as well to see if there is some help for that

 

The insomnia may be being caused/made worse by the stressors that are affecting you, so don't just think in terms of directly  "addressing the insomnia".  Learning and using non drug coping skills as part of every day can help to reduce the stress as well as learning life coping skills because you won't be as worried.

[luvkids]

23 minutes ago, ChessieCat said:

When reducing/going off a drug, it can be very easy to think that what we are experiencing is withdrawal when it is possible that there is something else that is causing the symptoms or making withdrawal symptoms worse.

 

 

America has also has/had the riots and you've also got the upcoming election.  There is a lot of external stressors affecting people at the moment.

 

 

The insomnia may be being caused/made worse by the stressors that are affecting you, so don't just think in terms of directly  "addressing the insomnia".  Learning and using non drug coping skills as part of every day can help to reduce the stress as well as learning life coping skills because you won't be as worried.

 

[luvkids]

Just now, luvkids said:

 

I am not consciously worried about most of the stuff that is going on.  I think that by watching the news daily back in March and April I inundated my mind and soul with fear that may be underlying my insomnia,  plus it being caused by withdrawal.   I am not generally a worrier or anxious.  I no longer watch news, listen to the radio, or read the newspaper.  But my exhaustion level is such that I feel dizzy, sometimes stumble, at times have a hard time articulating or focusing on a task.  I have never felt this way, and it can't continue 

[ChessieCat]

On 8/2/2020 at 8:01 AM, ChessieCat said:

bijay has the same idea as me.  I was going to make the suggestion that you find things to do to distract yourself.

 

Just found this fantastic list of ideas.

 

https://www.getselfhelp.co.uk/distract.htm#OTHER IDEAS

[Altostrata]

Did the insomnia start when you were reducing Paxil?

 

You could reinstate citalopram (Celexa) instead of fluoxetine (Prozac). Suggest starting with the liquid, so you can try 1mg and see how it affects you. A lot of the time, if you have withdrawal syndrome, you can react badly to "normal" dosages. Don't let the doctor force you to take anything.

[ChessieCat]

I suggest that you rehearse what you are going to say beforehand.  If you know what you want to do and he suggests something different you can say that you would prefer to try your way first.  Listen to what the doctor has to say.  You need to be assertive without sounding like you know it all.  Also, you need to try and stay composed and not become emotional.  Remember that you are the "customer" and it is you that is going to be affected by what you do, not the doctor.  If he suggests something that you are unsure about you can always say that you would like to think about it before deciding.

 

how-to-talk-to-a-doctor-about-tapering-and-withdrawal-what-to-expect

[luvkids]

OK, guys....I guess you could say I have fallen off the bandwagon.  My symptoms had become intolerable, I was barely functioning, the insomnia so bad I could not think straight, was stumbling around, my husband was very worried about me, and I felt I simply could not go on this way.  Doctor prescribed 5 mg. Celexa.  I took just 2.5 mg. for 6 days, liquid form.  After several days my head began spinning, pulsing, feeling tingly.....symptoms I had not had before.  Contacted doctor (a different doctor since first one was on vacation) who said to discontinue Celexa  and prescribed Remeron 7.5 mg.  Doctor said to take 2 mg. Celexa for one week, then 1 mg. for one week, then .5 mg for one week, then discontinue.  My question for you is whether since I was only on it for 6 days, do I still need to do a 10% taper, or is it ok to taper at the rate the doctor suggested.  He initially said to just stop Celexa, but I told him I wanted to taper.  Not sure what to do about Remeron.  It is supposed to help with the insomnia, which had become chronic, 0-2 hours sleep for 6 weeks, as well as being good for anxiety.  Please advise.

[brassmonkey]

Having only been on it for six days a fast taper should be fine. The one he suggested would work or you could do 25% a week until off. there will probably be a stabilization period of several weeks after you come off during which symptoms will come and go.

[luvkids]

I assume it would not be wise to just stop taking the Celexa rather than tapering off it?  It seems to give me a lot more anxiety.  I stopped it for 2 days and on the second day got weird head feelings....tingling, spinning, pulsing...and had to lie down for 1.5 hours till it stopped.  But I almost prefer that to the increased anxiety.  But I want to do what will be best  in the long run.

[Shep]

On 8/24/2020 at 11:01 AM, luvkids said:

Contacted doctor (a different doctor since first one was on vacation) who said to discontinue Celexa  and prescribed Remeron 7.5 mg.  Doctor said to take 2 mg. Celexa for one week, then 1 mg. for one week, then .5 mg for one week, then discontinue.  My question for you is whether since I was only on it for 6 days, do I still need to do a 10% taper, or is it ok to taper at the rate the doctor suggested.  He initially said to just stop Celexa, but I told him I wanted to taper.  Not sure what to do about Remeron.  It is supposed to help with the insomnia, which had become chronic, 0-2 hours sleep for 6 weeks, as well as being good for anxiety. 

 

Please update your signature to reflect your recent drug changes. A direct link to your signature is here:

 

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As Brassmonkey wisely noted, a rapid taper is fine. It generally takes a month to develop a dependency, so you'll want to rapid taper off within a month. 

 

I would not start Remeron. This will be another drug you'll have to taper off and we have a number of members who struggle to get off this drug. 

 

Please check out the non-drug coping skills section:

 

Non-drug techniques to cope with emotional symptoms

 

For tips to help sleep:

 

Tips to help sleep: so many of us have that awful withdrawal insomnia

 

You might also want to try a bit of melatonin:

 

Melatonin for sleep

 

 

[bijay]

@luvkids Just wanted to check in - how are you doing?

[luvkids]

Things have been horrible.  Out of desperation for some kind of relief from crippling insomnia and  anxiety, in August I began taking 7.5 mg of Remeron, which was supposed to help with both the sleep and anxiety.  It maybe helped a bit at first with sleep, but no help with anxiety.  I now want to stop taking it and know I need to taper.  I have been on the 7.5 mg. for 3 months.  Do I need to do the 10%/month, or since It is a low dose and I have not been on it a long time, can I go faster?  I am hoping to get the liquid form, since I cannot imagine tapering with those tiny tablets.  The doctor said to either just stop taking it (NOT going to do that) or taper by cutting the tablet into quarters.  The tablet is way too small to successfully cut into quarters.  I have asked for liquid but do not know if it is available.   Is it safe to taper faster than 10% if I don't get withdrawal symptoms?

[ChessieCat]

Please update your drug signature.

 

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[ChessieCat]

 

2 hours ago, luvkids said:

The doctor said to either just stop taking it (NOT going to do that)

 

I'm really glad that you know better than to do what the doctor said.

 

Q:  Having you been taking any other drugs/supplements since August?  Benzo?

 

2 hours ago, luvkids said:

Is it safe to taper faster than 10% if I don't get withdrawal symptoms?

 

It can take as little as 1 month for the brain to fully adapt to a psychiatric drug.

 

And there is no way of knowing whether you can do a fast taper.  It's up to your brain.  It's better to go slower so as not to end up with withdrawal symptoms than to go too fast because once you get withdrawal symptoms it sometimes takes a lot of time to stabilise.  We have members here who took longer to get off their drug, than if they had stuck to 10% every 4 weeks, because they went too fast

 

Tips for tapering off mirtazapine (Remeron)

 

How is your sleep now compared to before you started Remeron?  You said that is helped to start with but I don't want you to compare it with that.

 

If your sleep has improved, even if a bit, then it might be better to taper the Remeron at 10% so as to maintain the improved sleep (if it has).

 

If you don't think it is helping your sleep you could try a faster taper.  Instead of reducing by a larger percentage it would probably be better to do a 10% reduction and if after 2-3 weeks you feel okay then you could reduce again.  I wouldn't reduce any sooner than 2 weeks after a reduction though because withdrawal symptoms might be delayed.  Sometimes they can be delayed for 3 weeks, but it seems that for most members they appear during the first 2 weeks.  But be aware that just because you aren't feeling withdrawal symptoms doesn't mean that your brain isn't still making adjustments but there is no way to know what it's doing.  You might be able to do a few quick reductions and then hold for a bit longer just to make sure.

 

What I've suggested above are just that, suggestions, a bit of brain storming of ideas for you to think about and tailor to your own situation.

 

You will need to keep a close eye on how the reductions affect your symptoms and hold for longer if necessary.  I urge you to be very cautious about how much and when to reduce.  And of course, holding for longer is better than reducing too soon.

[luvkids]

Thanks.  I am going to have to get the liquid Remeron from a compounding pharmacy since it is not readily available here.  Not sure what strength to get.  I am currently on 7.5 mg and they said they can make either 5 mg/ml or 10 mg/ml.  I am thinking the 10 would be better, otherwise I would have to take more than 1 m. to start.  What do you think?  I am not on any other drugs.  I take a multi vitamin plus fish oil, Vit. d3 and  magnesium and sometimes melatonin.  My sleep is still highly erratic and not really better than before I started the Remeron.  

[ChessieCat]

The 5mg/ml would provide more accurate measuring.

[luvkids]

If I get 5 mg/ml, won't I have to take more than 1 ml to start, until I get to 5mg or less? I was thinking to start with the 10 mg/ml and then switching to 5 mg/ml when I get to 5 mg or less.  But I can see your point.   Also, have you had any problems getting your doctor to keep giving refills, since they typically suggest a 3 week or so taper.  Obviously I will need more than 3 weeks worth of the liquid.

[ChessieCat]

 

6 hours ago, luvkids said:

Also, have you had any problems getting your doctor to keep giving refills, since they typically suggest a 3 week or so taper. 

 

how-to-talk-to-a-doctor-about-tapering-and-withdrawal-what-to-expect

 

There is PRINT OUT linked in Post #1 of this topic which I suggest that you take to your doctor.  It is from The College of Psychiatry and is endorsed by several professional medical organisations.

Ask the compounding pharmacist if the liquid can be diluted with water.  Only a bit at time, not the lot in one go.  Also ask how long it would keep in the fridge.

 

If you can dilute the liquid then you can get more accurate doses as well as be able to measure amounts less then 1mL, eg 0.x and 0.xx.  The lower the dose gets the more water you can use and you can get 0.xxx amounts or even smaller.

 

You might be able to take part of the dose as undiluted liquid and the balance diluted.

 

The lower the numbers in the ratio the more accurate a dose you can get.  So a 1:1 ratio means you have to take more than if you had a 5:1 or 10:1 ratio.  The more liquid you have to measure the more flexibility you will have to get the doses you need.

 

Here's what I'm currently doing.  I'm using the contents of a 2mg compounded capsule and adding it to 200mL of water.  The dose I need to add to my capsules is 0.06mg.  I measure out a 5mL and a 1mL syringe to get the dose.  If I put the 2mg in 20mL of water I would be having to measure 0.6mL of liquid with a 1mL syringe.  Measuring the total of 6mL is much easier and more accurate that trying to measure 0.6mL.

 

This member is currently taking 9mg and will be reducing to 8.xxmg soon and is taking prescription liquid Lexapro.  This was my suggestion about how to get the 0.xxmg portion of the dose:

 

25 minutes ago, ChessieCat said:

If your prescription liquid is 5mL/5mg then the ratio is 1:1 or 1mL = 1mg

 

You could take 8mg dose in prescription liquid and then dilute some to get the balance of your dose.  If you put 1mL prescription liquid in 10mL water (10:1 ratio) each 1mL liquid will = 0.1mg dose (divide both sides by 10).  You can then extract the unwanted portion and drink the rest.

 

Or you can dilute in 100mL water (100:1 ratio) and each 1mL will = 0.01mg dose.

 

Please double check the figures.  I'm human.

 

I hope that makes sense.

 

 

 

Edited November 7, 2020 by ChessieCat

[luvkids]

So I did a 10% taper for 2 weeks and am starting the second week of another 10%. What I am noticing is feeling very sedated during the daytime...downright drugged at times where I can barely keep my eyes open.  I know Remeron is more sedating at lower levels, but both a pharmacist and doctor said it does not get any more sedating below 7.5 mg, which was the original dose I was on.  It just makes me want to get off it faster so I don't feel like a zombie all the time.  Any thoughts about what is going on?

[ChessieCat]

Q:  What time do you take the Remeron?

[luvkids]

I take remeron at bedtime.  I wake up feeling sort of ok, but within a couple of hours I have to lie down. And then after lunch another rest.  By dinner time I can barely hold my head up.  Extremely sedated/drugged feeling.  Doctor said to try taking 1 mg less and see how I feel.

[ChessieCat]

Q:  Has this sedated feeling only started since you made the reduction/s?

 

If yes, then you may need to go slower rather than speeding up.

[ChessieCat]

Please update your drug signature with the date and dose whenever you make a change.  Thank you.

[luvkids]

The sedation started just a bit with the first drop, mostly just in the evening.  After the second drop I got the day time sedation.   What is odd is that on a day after I got no sleep, I did not feel the extreme sedation.  This past week I have had no sleep every other day. So after those nights I did not feel so drugged.